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Studies report interaction difficulties between patients with polycystic ovary syndrome (PCOS) and healthcare professionals (HCP). This systematic review and qualitative evidence synthesis aimed to collate and synthesize the existing peer-reviewed literature investigating challenges for people with PCOS when interacting with HCP. Medline, PsycInfo, EMBASE, All EBM and CINAHL were searched from 1990 to September 2022. Study risk of bias (RoB) was performed and all textual data relevant to challenging interactions between patients with PCOS and HCP were extracted and analysed using thematic synthesis. Of the 6353 studies identified, 28 were included. Two were appraised as high, four as moderate and 22 as low RoB. Four analytic themes were derived illustrating that interactions were challenging when: (i) medical information (PCOS, its management) was not shared in the best way; (ii) information provision and deliberation opportunities were insufficient to achieve outcomes that mattered to patients; (iii) interactions prompted but did not support patient activation; and (iv) health system-level barriers (e.g. policies and guidelines) were present or made worse by HCP behaviour. Future research should examine methods for the implementation and evaluation of established frameworks for sharing medical information and supporting patient agency in the context of PCOS care., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Research Question: From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention?, Design: Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting., Results: Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study., Conclusions: The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates., (Copyright © 2024. Published by Elsevier Ltd.)

Globally, fertility awareness efforts include well-established risk factors for fertility problems. Risks disproportionately affecting women in the Global South, however, are neglected. To address this gap, we conducted a systematic review and meta-analyses of relevant risk factors to examine the association between risk factors and fertility problems. MEDLINE, Embase, Cochrane Library, regional databases and key organizational websites were used. Three authors screened and extracted data independently. Studies assessing exposure to risk (clinical, community-based samples) were included, and studies without control groups were excluded. Outcome of interest was fertility problems, e.g. inability to achieve pregnancy, live birth, neonatal death depending on study. The Newcastle-Ottawa Scale was used to assess study quality. A total of 3843 studies were identified, and 62 were included (58 in meta-analyses; n = 111,977). Results revealed the following: a ninefold risk of inability to become pregnant in genital tuberculosis (OR 8.91, 95% CI 1.89 to 42.12); an almost threefold risk in human immunodeficiency virus (OR 2.93, 95% CI 1.95 to 4.42) and bacterial vaginosis (OR 2.81, 95% CI 1.85 to 4.27); a twofold risk of tubal-factor infertility in female genital mutilation/cutting-Type II/III (OR 2.06, 95% CI 1.03 to 4.15); and postnatal mortality in consanguinity (stillbirth, OR 1.28, 95% CI 1.04 to 1.57; neonatal death, OR 1.57, 95% CI 1.22 to 2.02). It seems that risk factors affected reproductive processes through multiple pathways. Health promotion encompassing relevant health indicators could enhance prevention and early detection of fertility problems in the Global South and disproportionately affected populations. The multifactorial risk profile reinforces the need to place fertility within global health initiatives., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Research Question: What are the emotional effects of infertility on patients, partners, or both, and how can qualitative thematic analyses and natural language processing (NLP) help evaluate textual data?, Design: A cross-sectional, multi-country survey conducted between March 2019 and May 2019. A total of 1944 patients, partners, or both, from nine countries responded to the open-ended question asking about their initial feelings related to an infertility diagnosis. A mixed-method approach that integrated NLP topic modelling and thematic analyses was used to analyse responses. Sentiment polarity was quantified for each response. Linear regression evaluated the association between patient characteristics and sentiment negativity., Results: Common emotional reactions to infertility diagnoses were sadness, depression, stress, disappointment, anxiety, frustration, confusion and loss of self-confidence. NLP topic modelling found additional reactions, i.e. shared feelings with partners, recollections about causes of infertility and treatment experience. Responses to the open-ended question were brief (median: three words) with 71.8% conveying negative sentiments. Some respondent characteristics showed small but significant associations with sentiment negativity, i.e. country (Spain, China and France were more negative than the USA, P < 0.001, P < 0.003 and P < 0.009 respectively), treatment engagement (no treatment was more negative than one or more treatment, P = 0.027) and marital status (missing/other was more negative than divorced, P = 0.003)., Conclusion: Infertility diagnoses create an emotional burden for patients and partners. The mixed-method approach provides a compelling synergy in support of the validity of these findings and shows potential for these techniques in future research., (Copyright © 2022. Published by Elsevier Ltd.)

Research Question: What is the psychological impact of infertility on infertile patients and partners of infertile patients?, Design: This online, international, quantitative survey assessed the impact of infertility on mental health, relationships and daily activities for 1944 respondents. Respondents were male or female infertile patients (n = 1037) or partners to infertile patients (n = 907; not necessarily partners of the patient sample) and were recruited at different stages of the treatment journey., Results: The most common emotions were 'sadness' at infertility diagnosis and 'anxiety' during treatment. Emotions differed in nature and intensity throughout the journey. Envy of others who achieved pregnancy was frequently reported by women. More than half of respondents (60.4%; n = 1174) perceived the infertility journey to have impacted their mental health, and 44.1% (n = 857) of respondents sought mental health support. More patients reported mental health impacts (70.1%, n = 727) than partners (49.3%, n = 447). One in three respondents indicated that their relationship had suffered due to the infertility diagnosis. Of these respondents, 55.0% (n = 409) strongly agreed that infertility caused an emotional strain. Patients more often than partners reported a detrimental impact on daily activities. Respondents most commonly agreed with statements regarding an 'effect on work-life balance'., Conclusion: Treatment journey stages are defined by their impact profile, which differs between infertile patients and partners of infertile patients. Negative impacts are diverse (mental health, relational, daily activities). There was disparity between the number of respondents reporting mental health issues and the number seeking mental health support. This indicates the need for support services tailored to different treatment stages., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Research Question: What are the key drivers and barriers for infertile patients and their partners to see an infertility specialist and initiate treatment?, Design: An online, international, 30-minute quantitative survey collected data from 1944 respondents from nine countries. Respondents were infertile patients (n = 1037) or partners of infertile patients (n = 907; but not necessarily partners of the patient sample), at different stages of the treatment journey., Results: The overall average times were 3.2 years to receiving a medical infertility diagnosis, 2.0 years attempting to achieve pregnancy without assistance before treatment, and 1.6 years of treatment before successful respondents achieved pregnancy. The most common driver for considering treatment after a consultation (n = 1025) was an equal desire within the couple to have a child (40.8%). Of the partners (n = 356), 29.8% reported that transparency of information from healthcare professionals about treatment expectations was important. A significantly higher proportion of respondents seeking treatment reported that healthcare professionals offered supportive services (61.2%) and mental health services (62.0%), than of the 207 respondents who did not seek treatment (32.4% and 36.7%, respectively; P < 0.001). Perceived cost was the most commonly reported barrier for respondents not seeking a consultation (37.5% of n = 352) or treatment (42.0% of n = 207). Of the 95 respondents who discontinued treatment, 34.7% discontinued due to the financial impact., Conclusions: Respondents reported significant delays to seeking treatment, probably negatively impacting the chances of achieving pregnancy. Motivational coherence within couples was a key driver and cost of treatment was the main barrier. Reported supportive service offerings by healthcare professionals were significantly associated with continuation of the treatment journey., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Research Question: What are the effects of using a fertility education chatbot, i.e. automatic conversation programme, on knowledge, intentions to improve preconception behaviour and anxiety?, Design: A three-armed, randomized controlled trial was conducted using an online social research panel. Participants included 927 women aged 20-34 years who were randomly allocated to one of three groups: a fertility education chatbot (intervention group), a document about fertility and preconception health (control group 1) or a document about an irrelevant topic (control group 2). Participants' scores on the Cardiff Fertility Knowledge Scale and the State-Trait Anxiety Inventory, their intentions to optimize preconception behaviours, e.g. taking folic acid, and the free-text feedback provided by chatbot users were assessed., Results: A repeated-measures analysis of variance showed significant fertility knowledge gains after the intervention in the intervention group (+9.1 points) and control group 1 (+14.9 points) but no significant change in control group 2 (+1.1 points). Post-test increases in the intentions to optimize behaviours were significantly higher in the intervention group than in control group 2, and were similar to those in control group 1. Post-test state anxiety scores were significantly lower in the intervention group than in control group 1 and control group 2. User feedbacks about the chatbot suggested technical limitations, e.g. low comprehension of users' words, and pros and cons of using the chatbot, e.g. convenient versus coldness., Conclusions: Providing fertility education using a chatbot improved fertility knowledge and intentions to optimize preconception behaviour without increasing anxiety, but the improvement in knowledge was small. Further technical development and exploration of personal affinity for technology is required., (Copyright © 2020 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Research Question: Is it feasible to perform a future definitive trial to determine the effectiveness of the positive reappraisal coping intervention (PRCI) in improving the psychological well-being of women with recurrent pregnancy loss (RPL) during the early stages of a new pregnancy?, Design: This mixed method study aimed to establish the feasibility of conducting a multicentre randomized controlled trial (RCT) to definitively test the effects of the PRCI on the psychological well-being of women with RPL. Participants (n = 75) were recruited to the study and at the point of a positive pregnancy test, 47 were randomized into two study groups. The intervention group received the PRCI and weekly questionnaire assessment (Hospital Anxiety and Depression Scale and Weekly Record Keeping Form [WRK]) to monitor psychological well-being; the control group received the same questionnaires. Nested within the RCT was a qualitative process evaluation (QPE) exploring participants' subjective experience of study methods and the intervention. The study was conducted over a two-year period between 2014 and 2016., Results: This study successfully gathered knowledge about the feasibility aspects of conducting a future multicentre definitive study to determine the effects of the PRCI on the psychological well-being of women with RPL. Participants were receptive to its use and the intervention appeared to convey benefits with no apparent downside., Conclusions: The study concluded that a definitive RCT of the PRCI is possible and that the model of care already has the potential to be made more widely available as a safe, low-cost, convenient and easily deliverable intervention to provide much-needed support to a vulnerable patient population., (Copyright © 2020 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: The health belief and transtheoretical model were used to describe how women make decisions about fertility preservation (FP) and identify factors that predict their decisions., Methods: This is a two-year prospective study with 107 childless women aged 30-37. Women filled anonline survey assessing individual factors, intentions to do FP, variables of the health belief model, FP decisional stage and FP behaviour., Results: Women´s intentions, desire and number of children wanted decreased, fertility knowledge and perceived susceptibility to infertility increased and perceived severity of infertility decreased. A low number of women progressed through the stages of the decision-making process. Only 14% reached a decision and all decided not to do FP. Women's baseline intentions to do FP predicted their decision., Conclusion: Women at the optimal age range to do FP (28-35 years) do not engage in decision-making about it, which reflects their initial low intentions to do FP. Women's decision about FP is influenced by their perceptions about the technique., Pratical Implications: Women with a high desire for parenthood and within the optimal age range to do FP should receive accurate information about it and could benefit from prompts to engage in active decision-making about doing it., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The Cardiff Fertility Knowledge Scale (CFKS) and the Fertility Status Awareness Tool (FertiSTAT) are validated tools allowing the evaluation of fertility knowledge and raising awareness about risk indicators for reduced fertility. Their use by health care professionals practicing in the field of reproductive health might optimize fertility of the Canadian population. However, there currently is no version of these questionnaires for the French-Canadian population. The objective of this study was to translate and culturally adapt the CFKS and FertiSTAT to the French-Canadian population., Methods: The translation and adaptation of the questionnaires was completed following a four-stage approach: (1) forward translation, (2) synthesis, (3) expert committee review, and (4) testing of the prefinal version of the questionnaires. The testing stage was conducted with a sample of 30 women and 10 men., Results: During the translation process, linguistic difficulties were met for some items of both questionnaires but were resolved by consensus of the expert committee. Thirty women and 10 men tested the prefinal version of the CFKS-F and FertiSTAT-F. On a 5-point Likert scale, the global comprehension was 4.8 ± 0.5 and 4.6 ± 0.6, respectively. Based on the comments of the participants, the expert committee made minor modifications in the final version of the questionnaires to clarify the formulation of questions and adapt to one medical term., Conclusion: Tools to assess fertility knowledge and the presence of risk indicators for reduced fertility are now available for health care professionals practicing in the field of reproductive health., (Copyright © 2019 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed at evaluating the reliability of self-reported recent antibiotic use, including ability to name the antibiotic, among pharmacy customers from the general population., Methods: This cross-sectional observational study of adults took place in pharmacies in northeastern France from January to April 2016. Participants were asked if they had used any antibiotics in the preceding 4 months and if so, to name them. Their reports were compared with an electronic pharmacy dispensing record listing all of the medication dispensed to them in France., Results: The study included 653 individual customers from 15 pharmacies. Antibiotics had been dispensed 325 times, according to the records, but the patients reported only 237 courses of treatment. Agreement between self-report and the electronic record about whether or not they had used an antibiotic was 80% (κ 0.60). Among the discordant responses, 57% (81/143) involved underreporting. Only 24% (79/325) of the patients could name the antibiotic for each course of treatment; 49% (160/325) could not. The multivariate analysis showed that patients who had purchased an antibiotic in the previous 30 days were 2.5 times more likely to know its name (p 0.01)., Conclusions: Participants' self-reports were relatively reliable for recent use of an antibiotic, but not for its name. Because physicians cannot base prescription decisions on these self-reports only, an electronic pharmacy dispensing file shared among prescribers would be useful., (Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Objective: We aimed to assess the acceptability of antibiotic stewardship measures by family physicians., Material and Methods: We conducted an online cross-sectional survey in 2015 with a sample of family physicians practicing in a specific French region., Results: Overall, 283 of 1171 family physicians (24%) completed the questionnaire. Decision-support tools for antibiotic prescribing and educational measures were well accepted by family physicians: 71% strongly agreed with a free distribution of urine dipstick tests and 54% with incentives to participate in antibiotic training sessions. Almost all family physicians did not agree with restrictive measures: 68% were for instance opposed to having to justify the prescription's compliance with guidelines on the prescription itself. Physicians also did not agree with restrictive measures when they only applied to physicians prescribing many antibiotics., Conclusion: Participants were probably the most motivated and aware of the topic physicians, but they were particularly hostile to the introduction of restrictive measures related to antibiotic prescribing. Our survey was conducted with a large sample of family physicians and could help orientate our country's antibiotic stewardship policy. However, family physicians are likely to oppose any measure aiming at restricting their freedom of prescription., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: Antibiotics are still often inappropriately prescribed in France despite specific measures being taken for over 10years. The 25% decrease in antibiotic prescription advocated in the 2011-2016 National Antibiotic Plan seems difficult to achieve. One of the strategies currently considered in France is the use of a specific prescription form dedicated to antibiotics, with an educational message for patients. We aimed to evaluate the acceptability - by primary care prescribers - of this measure and to evaluate their perception of other antibiotic stewardship strategies., Methods: Qualitative study conducted among family physicians, pediatricians, dermatologists, dentists, and ENT specialists using semi-structured interviews. A thematic and framework analysis was then performed., Results: Thirty prescribing physicians practicing in a specific region of France were included in the study. The dedicated prescription form for antibiotics was deemed excessive and questionable. Other measures, not directly targeting prescribers, were rather well perceived: the unit sales of antibiotics, the restricted reporting of susceptibility tests, or the limitation of the number of molecules available in outpatient settings., Conclusion: The results of this exploratory study may guide the national antibiotic stewardship policy in France., (Copyright © 2016. Published by Elsevier SAS.)

Background: Providing medications for the management of acute cough in infants less than 24 months, a frequent reason for medical consultation, has recently been reduced by the contraindication of various antitussive specialties in France., Objectives: The objective of this study was to assess the expectations and fears of coughing infants' parents, to determine their representations of coughing, and to quantify the use of self-medication and the risk of a deferral requests to prescribe other drug classes., Methods: An opinion and cross-survey was carried out with parents of infants under 24 months of age. A multiple-choice questionnaire was proposed to them in day care centers and Mother and Infant Welfare centers. The data collected were analyzed descriptively and using the Chi(2) test. Logistic regression enabled us to interpret some of the results., Results: Sixty-four percent of parents expect an antitussive treatment from the doctor. For most parents, lifestyle modifications are well integrated (nasal irrigation, considered effective cough relief, hydration, smoking cessation). For 33 % of parents, corticosteroids are an alternative therapy to stop cough. Nearly half (43 %) of parents have sought treatment from their doctor, usually nasal suspensions, corticosteroids, and saline irrigation. Regarding self-medication, 30 % of parents have already given cough syrup or an antitussive suppository without a prescription, in order to stop the cough rapidly for 66 % of them. These parents seem more worried by coughing than other parents (P=0.0110, CI: 0.217; 1.751) as did those who had only one child (P=0.0029, CI: 0.120; 0.582)., Conclusions: This study suggests that a large majority of parents understand and accept the new recommendations. But one-third of parents are still worried, not knowing what to do without prescribed medications, which led them to give nonprescription cough syrups and ask for inappropriate treatments. It seems essential to inform parents about the natural history of infant coughing and educate them on lifestyle rules to reduce the risk of deferral prescription., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The optimal age to cryopreserve oocytes for later use is before 36 years. Current users are on average 38 years old. In this cross-sectional study an online survey was constructed about the factors associated with the intentions of childless women aged 28-35 years to use fertility preservation (FP). Questions were derived from the Theory of Planned Behaviour (attitudes and subjective norms regarding FP and perceived behaviour control to do FP) and the Health Belief Model (perceived susceptibility of infertility, perceived severity of childlessness, barriers and benefits of FP and cue to use FP). Also addressed were parenthood goals, fertility knowledge and intentions to use FP within 2 years. The data were analysed using structural equation modelling. The Health Belief Model showed a good fit to the data (χ(2) [14, n = 257] = 13.63, P = 0.477; CFI = 1.000: RMSEA = 00, 90% CI [0.00-0.06]). Higher intentions to use FP were associated with feeling susceptible to infertility, considering FP useful to achieve parenthood, perceiving the implications of infertility as severe, expecting to have children at a later age and having fewer ethical concerns. This suggests an increase of fertility awareness is necessary for the optimal use of FP., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To compare the percentages of men and women treated for primary arterial hypertension presenting with at least one target organ damage; to identify factors associated with target organ damage and/or blood pressure control., Methods: Observational, transverse study carried out between March 2012 and July 2013 on a representative sample of 2666 outpatients (including 1343 men) consulting general practitioners (n=469) or cardiologists (n=250) in routine follow-up., Results: Characteristics "men vs. women" were: mean age (62.6 ± 11.6 vs. 57.4 ± 14.7 years; P<0.0001); ≥ 60 years (61.1% vs. 43.9%; P<0.0001); waist circumference (98.9 ± 12.2 vs. 89.4 ± 14.3 cm; P<0.0001); SBP (146.5 ± 16.1 vs. 145.8 ± 17.0 mmHg; NS); DBP (85.1 ± 10.3 vs. 84.2 ± 10.4; P=0,03). Target organ damage was more frequent in men (37.6% vs. 22.9%; P<0.0001), whether it was subclinical (20.4% vs. 13.6%; P<0.0001) or documented (26.3% vs. 13.5%; P<0.0001); some patients presented with both types of damages. Men developed more often microalbuminuria (6.5% vs. 4.3%; P=0.01) and LVH (16.3% vs. 10.5%; P<0.0001); some patients presented with both types of subclinical injuries. Target organ damage was more common in men without regular physical activity than in those exercising regularly (42.1% vs. 32.5%; P=0.0004). Regular exercises had no effect in women (24.1% vs. 21.3%). For both sexes, other factors associated with target organ damage were: age ≥ 60 years, myocardial infarction/sudden death in family history, LDL-cholesterol ≥ 1.60 g/L, HDL-cholesterol ≤ 0.40 g/L. Stroke before 45 years in family history was a predictive factor in women. Hypertension was controlled in one third of patients without difference between sexes. In women, hypertension was less often controlled in case of excessive alcohol consumption compared to normal alcohol intake (17.9% vs. 36.1%; P=0.0007); this factor had no effect in men (28.1% vs. 32.6%). Other factors associated with poor blood pressure control were: BMI (P=0.002), LDL-cholesterol ≥ 1.60 g/L in women. In men, the factors were: tobacco, presence of LVH, absence of physical activity, HDL-cholesterol ≤ 0.40 g/L, absence of diet., Conclusion: In a hypertensive population, target organ damage is more common among men despite similar blood pressure control rates for both sexes., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To compare macular hole (MH) closure and visual acuity improvement after vitrectomy using SF6 versus C3F8 gas tamponade. The secondary purposes were to report the cumulative incidence of cataract development at 1 year after MH surgery and the proportion of complications., Design: Prospective, randomized study., Participants: Thirty-one patients were prospectively randomized to the SF6 group and 28 patients to the C3F8 group., Methods: Preoperative data included MH minimum diameter, Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA), cataract staging, and intraocular pressure (IOP) measurement. Postoperative data included optical coherence tomography confirmation of the closure at 6 weeks and 1 year, and ETDRS BCVA and cataract development/extraction, both 1 year after the MH surgery., Results: Primary MH closure was achieved in 93.3% in the SF6 group and 92.9% in the C3F8 group. Mean ETDRS BCVA improved by 17.7 letters in the SF6 and 16.9 letters in the C3F8 group. The difference in cumulative incidence of cataract development and extraction between both groups was not statistically significant. Regardless of the dye used, similar results were achieved. Finally, the proportion of adverse events was similar in both groups., Conclusions: MH surgery with SF6 gas achieves results similar to C3F8 in terms of visual acuity improvement, MH closure, cataract development/extraction, and adverse events., (Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Fever in children is frequent. Often mild, initial care is the parents' responsibility: medicinal treatments and medical consultations. Unfortunately, the efficiency of parental care is poor. Therefore, in 2005 the AFSSAPS updated its recommendations. One and 6 years after publication of the guidelines, this study rates their impact by describing and comparing parents' knowledge and behavior when faced with fever in their children., Material and Methods: This survey was conducted in families whose children were attending preschool in and near Metz (France) in 2006 and 2012. The same questionnaire was given to assess the knowledge, care, and symptoms of serious fever. The results were processed based on the number of children in the family and the family's socioeconomic category., Results: In 2006, 1038 questionnaires were distributed and 1273 in 2012. The fever threshold was not better known in 2012. Bathing and uncovering children remained the predominant physical methods used. Treatment was based on the use of ibuprofen and alternating treatments. However, the conditions of administering medication were well known to parents. The causes and motives for consultation were not better understood in 2012 however. The main source of information was physicians., Discussion: The message disseminated since 2005 has not been efficient. Its complexity has not eradicated old beliefs and inappropriate parental practices. A campaign based on a brief, simple message has to be organized, providing better chances of being assimilated by the public. Medical practices should be standardized., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objectives: The authors conducted a survey of measures implemented in France and abroad for a better use of antibiotics in general practice., Methods: A literature review was conducted from January 2000 to July 2014. Emails were sent to every infectious diseases department, to all regional health authorities (ARS), to the health insurance offices (CPAM) with the highest and lowest antibiotic use, and to the ministry of health to make an inventory of all antibiotic stewardship programs. The ministry of health, the board of general practitioners, infectious diseases specialists, pharmacists, and the medical and pharmacy schools of the nation's capital were contacted in 17 countries of Europe and North America., Results: The main measures implemented in France were training of healthcare professionals, publishing guidelines, feedback to the practitioners on their prescriptions, and availability of rapid diagnostic tests. Telephone networks were created in some regions, such as Antibiolor or Medqual, to help physicians with antibiotic prescription. Many foreign countries issued pedagogical material to physicians, for patients to explain what to do in case of viral infection or delayed prescription. In Alberta (Canada), the government introduced an optional authorization for quinolones. In Denmark, the government temporarily suspended the reimbursement of some agents to preserve them according to bacterial ecology. In the United-Kingdom, the antibiotic susceptibility test report must include less than 5 agents., Conclusions: The measures implemented in France and abroad were usually more persuasive than restrictive. But the bacterial resistance crisis should lead to implementing more restrictive measures., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To investigate whether different dimensions of patient centred care (PCC) were directly associated with wellbeing or indirectly, via lower concerns about medical procedures and/or increased tolerability of treatment., Methods: Cross-sectional study with 322 women and 111 men undergoing fertility diagnosis or treatment recruited online and in clinical setting. Participants completed questionnaires that assess PCC (PCQ-Infertility), individual (BSI Anxiety and Depression subscales) and relational wellbeing (FertiQoL Relational Domain), treatment concerns (CART Procedural Concerns scale) and tolerability (FertiQoL Tolerability Domain) and they filled a socio-demographic and fertility data file., Results: All dimensions of PCC were positively associated with better wellbeing except for organization of care. Information provision and continuity of care were indirectly associated with better individual wellbeing, the first via lower treatment concerns and the second via higher treatment tolerability. Competence, accessibility, continuity and communication were indirectly associated with better relational wellbeing via higher treatment tolerability., Conclusions: Patient centred care promotes wellbeing during treatment. PCC is directly associated to wellbeing but also indirectly. The mode of action of the different PCC dimensions on wellbeing varies., Practical Implications: To promote patients' wellbeing during treatment clinics should provide treatment related information and allow patients to establish a stable clinical relationship with a trustworthy and competent physician., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

The most salient psychological issue in the article 'Cassandra's prophecy' is the lack of fertility knowledge. This lack of knowledge exhibited by both Jane and the medical professionals resulted in a delay in trying to get pregnant and in seeking and receiving appropriate care, ultimately resulting in inadvertent childlessness. We identify five educational initiatives to increase fertility knowledge and personal awareness in order to promote informed decision-making about fertility health issues. These initiatives cover: (i) better sexual education for children; (ii) family planning for young adults that involves value and preference clarification about future parenthood goals; (iii) public health campaigns to increase awareness of the risk factors associated with reduced fertility; (iv) investigation of adherence to fertility guidelines within the medical profession; and (v) clearer information about the benefits and limitations of available fertility treatment. The future of fertility health care must be centred on providing people with information leading to informed choice about all aspects of their own fertility health. Empowerment may mean that people can better optimize their fertility health and be more likely to reach their parenthood goals., (Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

This study investigated the impact of women's body mass index (BMI) on the outcome after consecutive IVF/intracytoplasmic sperm injection cycles in 487 patients initiating treatment with 5-year follow-up. The total number of cycles was 1417. In total 103 (21.1%) were overweight (BMI 25-29.9 kg/m²) and 59 (12.1%) were obese (BMI ≥ 30 kg/m²). Number of initiated cycles/woman (P=0.01), number of cancelled cycles/woman (P < 0.01) and the total dose of gonadotrophin used/cycle (P < 0.01) rose with increasing BMI. A negative linear association between BMI and the number of retrieved oocytes (B=-0.243, P < 0.001) and an inverse U-shaped relationship between BMI and the number of developed embryos was seen, with less embryos available among underweight and obese women (P=0.03). The number with positive serum human chorionic gonadotrophin/cycle decreased significantly with increasing BMI (P < 0.01). The ongoing pregnancy rate/cycle among the obese women was lower (20.8% versus 28.3% in normal-weight women; P=0.04). Live-birth rate per cycle was 15.2% versus 21.5%. Multiple logistic regression analysis showed that the only independent predictors of live birth were women's age (P=0.037), women's BMI (P=0.034) and men's age (P=0.040)., (Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: It is widely considered that exposure to maternal cigarette smoking in pregnancy has risk effects on offspring attention-deficit/hyperactivity disorder (ADHD). This view is supported by consistent observations of association. It is, however, impossible to be certain of adequate control for confounding factors with observational designs. We use a novel "natural experiment" design that separates prenatal environmental from alternative inherited effects., Methods: The design is based on offspring conceived with Assisted Reproductive Technologies recruited from 20 fertility clinics in the United Kingdom and United States who were: 1) genetically unrelated, and 2) related to the woman who underwent the pregnancy. If maternal smoking in pregnancy has true risk effects, association will be observed with ADHD regardless of whether mother and offspring are related or unrelated. Data were obtained from 815 families of children ages 4 years-11 years with parent questionnaires and antenatal records. Birth weight was used as a comparison outcome. The key outcome considered was child ADHD symptoms., Results: Association between smoking in pregnancy and lower birth weight was found in unrelated and related mother-offspring pairs, consistent with a true risk effect. However, for ADHD symptoms, the magnitude of association was significantly higher in the related pairs (beta = .102, p < .02) than in the unrelated pairs (beta= -.052, p > .10), suggesting inherited effects., Conclusions: Our findings highlight the need to test causal hypotheses with genetically sensitive designs. Inherited confounds are not necessarily removed by statistical controls. The previously observed association between maternal smoking in pregnancy and ADHD might represent an inherited effect.

Objective: To identify and describe the extent to which theory or theoretical frameworks informed the development and evaluation of decision support technologies (DSTs)., Methods: The analysis was based on the decision technologies used in studies included in the Cochrane systematic review of patient decision aids for people facing health screening or treatment decisions. The assumption was made that DSTs evaluated by randomized controlled trials, and therefore included in the updated Cochrane review have been the most rigorously developed., Results: Of the 50 DSTs evaluated only 17 (34%) were based on a theoretical framework. Amongst these, 11 decision-making theories were described but the extent to which theory informed the development, field-testing and evaluation of these interventions was highly variable between DSTs. The majority of the 17 DSTs that relied on a theory was not explicit about how theory had guided their design and evaluation. Many had superficial descriptions of the theory or theories involved. Furthermore, based on the analysis of those 17 DSTs, none had reported field-testing prior to evaluation., Conclusion: The use of decision-making theory in DST development is rare and poorly described. The lack of theoretical underpinning to the design and development of DSTs most likely reflects the early development stage of the DST field., Practice Implications: The findings clearly indicate the need to give more attention to how the most important decision-making theories could be better used to guide the design of key decision support components and their modes of action.

Background: Events during pregnancy and labour may influence the future health and well-being of offspring. Many studies rely on maternal reports of pre and peri-natal factors. Both maternal and child characteristics may potentially influence the reliability and accuracy of maternal recall. However, this has not been previously examined., Aims: To examine agreement between information from maternally reported questionnaires and medical records for a range of pre and peri-natal factors. To examine whether maternal and child characteristics influence the level of agreement with medical records., Methods: A survey of women who had school aged children born following in vitro fertilization (IVF) was carried out. Mothers completed a postal questionnaire booklet which included the Lewis and Murray scale which asks about antenatal and obstetric complications and the Strengths and Difficulties Questionnaire which assesses child behaviour problems. Antenatal case notes were also reviewed. Multi-centre ethical approval was obtained. Complete data were available for 126 women., Results: The agreement between maternal report and medical records was very good for the majority of outcomes examined (infant birth weight, infant admission to special care baby unit, method of delivery, smoking during pregnancy, high blood pressure/oedema during pregnancy). Exceptions were length of labour and alcohol use during pregnancy. However, alcohol use during pregnancy was not routinely recorded in medical records. Maternal characteristics did not substantially influence level of agreement for the majority of outcomes examined. Exceptions were that agreement for length of labour was better in women with more educational qualifications and that agreement for pre-natal smoking was worse in women from higher socio-occupational groups. There was little evidence that child behaviour problems influenced the level of agreement between maternal recall and medical records., Conclusions: For the majority of pre and peri-natal events examined, mothers can provide accurate reports in comparison to information from medical records.

Unlabelled: Paediatric fever is a frequent reason of consulting a paediatrician or a general practitioner (30% of paediatric consultations)., Aim of the Study: This investigation aimed at reporting the knowledge level concerning child's and infant's fever in a urban population and the resulting practices. Two thousand and six hundred questionnaires were distributed in June 2004 in the 29 scholar institutions of Metz agglomeration (France) classified in 3 categories according to socio-economical conditions of parents: 3 institutions of city centre (high socioeconomical conditions), 18 sub-urban institutions (intermediary conditions) and 8 institutions located in priority education zones (ZEP) (defavorable conditions)., Results: One thousand and thirty-eight questionnaires could be analyzed (40%): 176 in city centre, 634 in sub-urban zones and 228 in ZEP. Fever threshold at 38 degrees C is well-known and fever measuring methods used are mostly in accordance with the recommendations. The best room temperature was known and the use of antipyretic physical means underlined only a few cases of obvious mistakes. All parents were informed about worrying signs related with fever even if doctor's resort was excessive. Acetaminophen was the reference molecule before ibuprofen whereas the use of aspirin was decreasing. Antipyretic treatments methods used by parents were often unsuitable, leading to therapeutical inefficacy, overdosage or noxious drug interactions, mainly because of a lack of knowledge about drug components., Conclusion: This investigation underlines insufficient knowledge and noxious management practices among parents with unfavourable socio-economical conditions which lead us to recommend targeted information preferentially in areas gathering together most unfavourable socio-economical condition populations.

Objective: This study evaluates a patient education programme focussed on improving communication and stress management skills among couples in fertility treatment., Methods: In total, 37 couples completed the intervention. Two teachers conducted all the five courses offered. The effectiveness regarding communication and infertility-related stress was assessed by questionnaires immediately before (time T1) and after the intervention (time T2). Seeking of information and professional support was assessed at a 12-month follow-up (time T3); response rates were: T1, 93.2%; T2, 85.1%; T3, 74.3%. Data were compared at baseline (T1) and at the 12-month follow-up (T3) with a prospective cohort of Danish people in fertility treatment., Results: There were no differences in infertility-related stress at base line between the two groups studied. We estimated the bi-directional changes in communication, e.g., changes from talking often to talking less frequently and vice versa. More intervention participants started to talk often with their partner about infertility and its treatment after the intervention compared to those who stopped to talk often. Women and men changed occurrence, frequency and content of communication with close other people. Among women marital benefit increased significantly. Infertility-related stress was not reduced significantly. Significantly more intervention participants than in the comparison group had contacted support groups, a psychologist and/or agencies for adoption at the 12-month follow-up., Conclusion: The intervention resulted in important perceived improvement in the participants' competence to actively manage changes in marital communication and in communication in different social arenas., Practice Implications: We recommend fertility clinics to develop and evaluate different interventions for those fertility couples who ask for more psychosocial support.

Objective: To investigate (i) marital benefit, e.g., that infertility has strengthen the marriage and brought the partners closer together among people beginning fertility treatment and (ii) communication and coping strategies as predictors of marital benefit 12 months later., Methods: A prospective cohort design including 2250 people beginning fertility treatment and a 12-month follow-up. Data were based on self-administered questionnaires measuring marital benefit, communication, and coping strategies. The analyses of predictors were based on the sub-cohort (n=816) who had not achieved a delivery after fertility treatment., Results: 25.9% of women and 21.1% of men reported high marital benefit. Among men medium use of active-confronting coping (e.g., letting feelings out, asking others for advice) and use of meaning-based coping were significant predictors for high marital benefit. Having the infertility as a secret, difficult marital communication, and using active-avoidance coping (e.g., avoid being with pregnant women or children, turning to work to take mind off things) were among men significant predictors for low marital benefit. No significant predictors were identified among women., Conclusion: Fertility patients frequently experience marital benefit., Practice Implications: The study provides information about where to intervene with male fertility patients in order to increase their marital benefit after medically unsuccessful treatment.

Objective: The aim of this study was to develop a valid, reliable, and easy-to-administer instrument to assess patient satisfaction and perceived outcome after bilateral excimer laser photorefractive keratectomy., Design: Development and validation of a psychometric questionnaire., Participants: Consecutive patients who underwent bilateral excimer laser photorefractive keratectomy from May 1994 through May 1997 by 12 surgeons from four collaborating centers. To be eligible, a minimum of 4 months since the last surgery and a maximum of 30 months since the first surgery was required., Methods: The new instrument was derived in part from the Prospective Evaluation of Radial Keratotomy (PERK) study 10-year psychometric questionnaire and the Visual Functional Index (VF-14), an index of functional impairment in patients with cataract. Questions were grouped in seven scales, each covering a specific aspect of quality of vision. These included global satisfaction, quality of uncorrected vision, quality of corrected vision, quality of night vision, glare, daytime driving, and night driving., Main Outcome Measures: Acceptability, reliability, validity, and interpretability of the instrument, as well as its ease of administration., Results: The instrument scale structure was examined and scale scores were created. Item-discriminant validity ensured that questions belonged to their hypothesized scale, based on multitrait correlation analysis. The instrument was shown to be reliable by a high level of internal consistency, and all Cronbach's alpha coefficients were superior or equal to 0.83. Construct-related validity and interpretability were assessed based on correlations between scale scores and clinically recognized success criteria such as visual acuity and refraction. Respondent burden was shown to be minimal. Acceptability of the instrument was shown to be very good, with a participation rate of 74.3% (690 of 929 patients). The instrument is available in English and in French and the translation was shown to be reliable., Conclusions: The acceptability, reliability, and interpretability of the instrument, as well as its ease of administration, were shown to be adequate. This questionnaire appears clinically useful to document patient satisfaction after excimer laser photorefractive keratectomy.

Purpose: To document patient satisfaction and self-perceived quality of vision after bilateral photorefractive keratectomy (PRK)., Design: Noncomparative, interventional case series., Participants: Consecutive patients who underwent bilateral PRK from May 1994 through May 1997 by the 12 surgeons of four collaborating centers with a minimum of 4 months since the last surgery and up to 30 months since the first surgery., Methods: A questionnaire with known psychometric properties was self-administered by the patients., Main Outcome Measures: Responses to individual questions and scale scores., Results: A total of 929 questionnaires were sent, of which 690 were answered and returned (74.3% response rate). The preoperative spherical equivalent ranged from -0.38 diopters [D] to -27.75 D (mean, -5.32 D; standard deviation, 2.85 D). Although 91.8% of the patients were satisfied or very satisfied with their surgery, 96.3% considered that their main goal had been reached, and 95.7% would still choose to have surgery if they had it to do over. The degree of satisfaction was proportional to the postoperative uncorrected visual acuity in the best eye expressed in LogMAR (r = -0.18, P: = 0. 0001) and was negatively correlated with the importance of the corneal haze (r = -0.23, P = 0.0001). Daytime glare was reported to be greater than before surgery by 55.1% of patients. A decrease in night vision was reported by 31.7% of patients, and 31.1% of patients reported increased difficulty driving at night because of their vision., Conclusions: Overall satisfaction after PRK for low to severe myopia appears to be very good. Glare and night vision disturbance, particularly bothersome for night driving, seem to constitute significant secondary effects that deserve further investigation and should be kept in mind for future improvements in the technique.

In case-control studies conducted using computerized databases, controls are often selected as a random sample from the base population. This representative choice of controls is intended to guard against selection bias. We show, using data from a database case-control study, that such a definition of controls may also lead to selection bias under two conditions: (1) if the target disease has a prolonged asymptomatic clinical course with its detection depending on a specific physical examination and (2) if exposed patients have a higher likelihood of having the disease detected than unexposed patients. The extent of the bias that could result from the use of randomly selected controls was investigated in the context of a case-control study of the risk of ocular hypertension or glaucoma associated with the use of glucocorticoids, conducted using the Quebec universal health insurance computerized databases. This article also illustrates that a computerized database can be useful to empirically explore opportunities for bias.

Background: Ocular hypertension and open-angle glaucoma are well-known side-effects of treatment with topical ophthalmic glucocorticoids. There is uncertainty about the risk of these disorders with oral glucocorticoid therapy., Methods: Data from the Quebec universal health insurance programme for the elderly were used to identify 9793 patients with a new diagnosis of ocular hypertension or open-angle glaucoma, or on newly prescribed treatment for these disorders (cases). 38,325 controls were randomly selected from ophthalmology patients seen in the same month and year as the case (index date). Current use of oral glucocorticoids was defined as that within 14 days of the index date. All glucocorticoid doses were converted to the equivalent amount of hydrocortisone. The case-control analysis was done by conditional logistic regression and adjusted for age, sex, systemic hypertension, diabetes mellitus, ophthalmic glucocorticoids, glucocorticoid injections, and variables related to general health., Findings: The mean ages of cases and controls were similar (74.9 [SD 6.3] vs 74.7 [6.4]). The adjusted odds ratio of ocular hypertension or open-angle glaucoma for current users of oral glucocorticoids compared with non-users was 1.41 (95% CI 1.22-1.63). There was a dose-related increase in the adjusted odds ratios for current users: 1.26 (1.01-1.56) for less than 40 mg per day of hydrocortisone, 1.37 (1.06-1.76) for patients on 40-79 mg per day, and 1.88 (1.40-2.53) for patients on 80 mg or more per day. The odds ratios also increased with the duration of treatment over the first 11 months of exposure., Interpretation: The use of oral glucocorticoids increases the risk of ocular hypertension or open-angle glaucoma in elderly patients. In patients in this age-group who need long-term treatment with high doses of oral glucocorticoids, monitoring of intraocular pressure may be justified.

Accuracy of telephone-administered dietary recalls was determined for 159 elderly subjects by comparing the telephone recalls of single midday meals consumed at congregate meal sites with data on actual intake for the meals. Accuracy was determined for kinds of food eaten, size of portions eaten, and content of 15 nutrients. Exact agreement between the two data sources on the kinds of food eaten occurred for only 55% of the observed food items. For 5 of the 10 food groups evaluated, the bias in mean recalled portion-size data was less than 10%. There was evidence of attenuated regression slopes relating recalled to observed portion sizes for 4 of the 10 food groups; adjusted r2 values for the recalled portion sizes ranged from 0.02 to 0.94. Because errors in the recalls of the kinds and amounts eaten tended to go in different directions, the accuracy of the nutrient data was better than that for the food-item or the portion-size data. For 12 of the 15 nutrients evaluated, the bias in mean recalled intake data was less than 10%. Although the adjusted r2 values for the recalled nutrient data ranged from 0.24 to 0.58, there was evidence of attenuated regression slopes relating recalled intake to observed intake for only 5 of the 15 nutrients. We conclude that telephone contact is an acceptable way to obtain short-term dietary recall data from elderly subjects.